基于成本-效果分析的新辅助化疗联合手术与单纯手术治疗晚期食管癌的经济学评价  

Economic Evaluation on Neoadjuvant Chemotherapy Combined with Surgery and Surgery Alone in the Treatment of Advanced Esophageal Cancer Based on Cost-Effectiveness Analysis

作　　者：周辉 张引颖[1] 李朝娟 安媛媛 阮艺宏 韩永涛 陈丹镝[1] ZHOU Hui;ZHANG Yinying;LI Chaojuan;AN Yuanyuan;RUAN Yihong;HAN Yongtao;CHEN Dandi(College of Health Policy and Management,West China School of Public Health/West China Fourth Hospital,Sichuan University,Chengdu 610041,China;Dept.of Oncology,Sichuan Cancer Hospital,Chengdu 610042,China)

机构地区：[1]四川大学华西公共卫生学院/四川大学华西第四医院卫生政策与管理系,成都610041 [2]四川省肿瘤医院肿瘤科,成都610042

出　　处：《中国医院用药评价与分析》2022年第2期151-154,共4页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：四川省科技厅重点研发项目(No.2018SZ0199)。

摘　　要：目的:基于成本-效果分析,探讨新辅助化疗联合手术与单纯手术治疗晚期食管癌的经济性。方法:采用分层随机法将2007年6月至2014年12月四川省肿瘤医院等8家医院收治的451例临床分期为T1-4N1M0/T4N0M0的食管鳞状细胞癌患者分为研究组和对照组。对照组患者(n=227)采用单纯手术治疗,研究组患者(n=224)采用新辅助化疗联合手术治疗。根据食管癌的疾病进展过程,将疾病分为3种状态,即疾病无进展状态、复发/转移状态和死亡状态,建立马尔可夫(Markov)模型评价两种治疗方案的经济性。结果:模型运行10年显示,单纯手术方案、新辅助化疗联合手术方案治疗食管癌的成本分别为578 334.18、1 024 119.63元。新辅助化疗联合手术方案治疗食管癌的增量成本-效果比为19 209.26元/QALY。结论:新辅助化疗联合手术方案的增量成本-效果比为19 209.26元/QALY,远低于四川省2019年的意愿支付阈值55 774元/QALY。因此,新辅助化疗联合手术方案具有显著的成本-效果优势。OBJECTIVE: Based on cost-effectiveness analysis, to probe into the economical efficiency of neoadjuvant chemotherapy combined with surgery and surgery alone in the treatment of advanced esophageal cancer. METHODS: Totally 451 patients with esophageal squamous cell carcinoma in the clinical stages of T1-4 N1 M0/T4 N0 M0, treated in 8 hospitals including Sichuan Cancer Hospital from Jun. 2007 to Dec. 2014, were divided into research group and control group via stratified random. The control group(227 cases) was given surgery alone, while the research group(224 cases) was given neoadjuvant chemotherapy combined with surgery. According to the disease progression of esophageal cancer, the disease was divided into three states, namely disease-free state, recurrence/metastasis state and death state, so that the Markov model was established to evaluate the economical efficiency of the two treatment regimens. RESULTS: The model run for 10 years showed that the cost of regimens of surgery alone and neoadjuvant chemotherapy combined with surgery for esophageal cancer were 578 334.18 yuan and 1 024 119.63 yuan, respectively. The incremental cost-effectiveness ratio of neoadjuvant chemotherapy combined with surgical regimen for esophageal cancer was 19 209.26 yuan/QALY. CONCLUSIONS: The incremental cost-effectiveness ratio of neoadjuvant chemotherapy combined with surgery regimen was 19 209.26 yuan/QALY, which is much lower than the willingness-to-pay threshold of 55 774 yuan/QALY in Sichuan Province in 2019. Therefore, neoadjuvant chemotherapy combined with surgery regimen has a significant cost-effectiveness advantage.

关 键 词：食管癌 新辅助化疗 MARKOV模型 成本-效果分析 

分 类 号：R979.1[医药卫生—药品] R956[医药卫生—药学]